Nursing Home Diversion Training Presentation

1. Nursing Home DiversionTraining Presentation How to Report and Document Abuse, Neglect, and Exploitation

2. Purpose Of This Training As a Home & Community Base Medicaid Waiver Provider, one of your roles is to ensure the health, safety and well-being of all your clients. The purpose of this training is to instruct you on the following: • How to report Abuse, Neglect, and Exploitation

3. How Does Florida Define Abuse, Neglect and Exploitation? It is Defined as…. • A person who is believed to have been Abused or Neglected by a caregiver in Florida; or • Suffering from the ill effects of Neglect by Self and is need of service; or • Exploited by any person who stands in a position of trust or confidence, or any person who knows or should know that a vulnerable adult lacks capacity to consent and who obtains or uses, or endeavors to obtain or use, their funds, assets or property.

4. Who is Responsible for Enforcing Florida Abuse, Neglect and Exploitation Policy? According to Chapters 39 and 415, of the Florida Statutes, the Florida Department of Children & Families is charged with: • Providing comprehensive protective services for children who are abused, neglected or at threat of harm and; • Vulnerable adults who are abused, neglected or exploited in the state

5. DCF DEFINITIONS • Abuse Any willful act or threatened act by a relative, caregiver, or household member which causes or is likely to cause significant impairment to a vulnerable adult’s physical, mental, or emotional health. • Abuse includes acts and omissions.

6. DCF DEFINITIONS (CONTINUED) • Neglect • Failure or omission on the part of the caregiver or vulnerable adult to provide the care, supervision, and services necessary to maintain the physical and mental health of a vulnerable adult, including but not limited to food, clothing, medicine, shelter, supervision and medical services, which a prudent person would consider essential for the well being of a vulnerable adult

7. DCF DEFINITIONS (CONTINUED) • The term “neglect” also means the failure of a caregiver or vulnerable adult to make a reasonable effort to protect a vulnerable adult from abuse, neglect or exploitation by others. • “Neglect” is repeated conduct or a single incident of carelessness, which produces or could reasonably be expected to result in serious physical or psychological injury, or a substantial risk of death.

8. DCF DEFINITIONS (CONTINUED) • Exploitation • A person who stands in a position of trust and confidence with a vulnerable adult knowingly, by deception or intimidation, obtains or uses, or endeavors to obtain or use, a vulnerable adult’s funds, assets, or property with the intent to temporarily or permanently deprive a vulnerable adult of the use, benefit, or possession of the funds, assets, or property for the benefit of someone other than the vulnerable adult.

9. DCF DEFINITIONS (CONTINUED) • Exploitation also occurs When a person who knows or should know that the vulnerable adult lacks the capacity to consent, obtains or uses, or endeavors to obtain or use, the vulnerable adult’s funds, assets, or property with the intent to temporarily or permanently deprive the vulnerable adult of the use, benefit, or possession of the funds, assets, or property for the benefit of someone other than the vulnerable adult.

10. DCF DEFINITIONS (CONTINUED) • Sexual Abuse • Acts of a sexual nature committed in the presence of a vulnerable adult without that person’s informed consent. • Sexual abuse includes, but is not limited to the acts defined in Section 794.011(1)(h), Florida Statutes, fondling, exposure of a vulnerable adult’s sexual organs, or the use of a vulnerable adult to solicit for or engage in prostitution or sexual performance. • Sexual abuse does not include any act intended for a valid medical purpose or any act that may reasonably be construed to be normal caregiving action or appropriate display of affection

11. DCF DEFINITIONS (CONTINUED) • Vulnerable Adult • A person 18 years of age or older, whose ability to perform the normal activities of daily living, or to provide for his or her own care or protection is impaired due to a mental, emotional, long term physical, or developmental disability or dysfunction, or brain damage, or the infirmities of aging.

12. Reporting Abuse/Neglect/Exploitation of a Vulnerable Adult • Requiring that reports of abuse, neglect, threatened harm, or exploitation be made to the Florida Abuse Hotline @1-800-96-ABUSE or 1-800-962-2873 • Everybody in the State of Florida is a Mandatory Reporter. Florida Statues 415.1034  states Mandatory reporting of abuse, neglect, or exploitation of vulnerable adults; and mandatory reports of death.

13. INDICATORS OFABUSE, NEGLECT, ANDEXPLOITATION Physical Indicators 1.UNEXPLAINED BRUISES OR WELTS: • 􀂄 On face, lips, mouth, torso, back, buttocks, thigh • 􀂄 In various stages of healing • 􀂄 Reflecting shape of article used to inflict (electric cord or belt buckle) • 􀂄 In several different surface areas 2. UNEXPLAINED FRACTURES: • 􀂄 To skull, nose, facial structure • 􀂄 In various stages of healing • 􀂄 Multiple or spiral fractures

14. INDICATORS OFABUSE, NEGLECT, ANDEXPLOITATION 3. UNEXPLAINED BURNS: • 􀂄 Cigar, cigarette burns, especially on palms, legs, arms, back or soles of feet • 􀂄 Immersion burns (sock like, glove like, dough-nut shaped on buttocks) • 􀂄 Patterned like objects (electric burner, etc.) 4. UNEXPLAINED LACERATIONS: • 􀂄 Mouth, lips, gums, eye or to external genitalia

15. SEXUAL ABUSEINDICATORS • 􀂄 Difficulty in walking/sitting • 􀂄 Torn, shredded or bloody undergarments • 􀂄 Bruises or bleeding in external genitalia, vaginal or anal areas • 􀂄 Venereal disease • 􀂄 Pregnancy

16. OTHER INDICATORS OF ABUSE: • 􀂄 Severe or constant pain • 􀂄 Obvious illness which requires medical or dental attention • 􀂄 Emaciated (so that individual can hardly move or so thin bones protrude) • 􀂄 Unusual lumps, bumps or protrusions under the skin • 􀂄 Hair thin as though pulled out, bald spots • 􀂄 Scars • 􀂄 Lack of clothing • 􀂄 Same clothing all of the time • 􀂄 Fleas, lice on individual • 􀂄 Rash, impetigo, eczema • 􀂄 Unkempt, dirty • 􀂄 Hair matted, tangled or uncombed

17. ENVIRONMENTAL INDICATORS • 􀂄 Garbage thrown about yard and house, high weeds and overgrown yard • 􀂄 Hazardous living conditions due to lack of repairs, utilities and/or equipment • 􀂄 Human and/or animal excrement on floors and furniture • 􀂄 Evidence of obvious fire hazards, such as piles of boxes, newspapers, old clothes, unvented gas heaters and blocked exits • 􀂄 Large number of animals lacking care

18. ENVIRONMENTAL INDICATORS 1.FOOD AND CLOTHING: • 􀂄 Little or no food in the house • 􀂄 Food is spoiled or lying around • 􀂄 Insufficient clothing for the weather 2. SOCIAL DEPRIVATIONS: • 􀂄 No evidence of social visits, television, radio, books or any kind of social, mental, or emotional stimulation • 􀂄 House is physically isolated from community • 􀂄 Lack of friends of a similar age and/or interests • 􀂄 Attempt by caregiver to isolate the individual from others

19. FINANCIAL EXPLOITATION: • 􀂄 Little or no money available until the next check arrives WHEN, income is ample to meet needs. • 􀂄 Activity in bank accounts that is inappropriate to the aged person or disabled adult (e.g., withdrawals from automated bank machines when the person cannot walk or get to the bank) • 􀂄 Power of attorney given when the individual is unable to comprehend the financial situation. • 􀂄 Recent will when the individual is clearly incapable of making a will. 􀂄 Lack of amenities (e.g., television, personal grooming items, appropriate clothing when the estate can well afford such items), personal belongings missing (includes art, silverware, jewelry)

20. BEHAVORIAL INDICATORS DESTRUCTIVE BEHAVIOR OF VICTIM: • 􀂄 Assaults others • 􀂄 Destroys belongings of others or themselves • 􀂄 Threatens self-harm or suicide • 􀂄 Inappropriately displays rage in public • 􀂄 Steals without an apparent need for the things stolen • 􀂄 Recent or sudden changes in behavior or attitudes

21. BEHAVORIAL INDICATORS • 􀂄 Afraid of being alone • 􀂄 Suspicious of other people and extremely, afraid others will harm them • 􀂄Shows symptoms of withdrawal, severe hopelessness, helplessness • 􀂄 Constantly moves from place to place • 􀂄 Frightened of caregiver • 􀂄 Overly quiet, passive, timid • 􀂄 Denial of problems

22. BEHAVIOR OF FAMILY OR CAREGIVER • 􀂄 Marital or family discord • 􀂄 Striking, shoving, beating, name-calling, scapegoating • 􀂄 Hostile, secretive, frustrated, shows little concern, poor self-control, blames adult, impatient, irresponsible. • 􀂄 Denial of problems • 􀂄 Recent family crisis • 􀂄 Inability to handle stress • 􀂄 Recent loss of spouse, family member, or close friend

23. BEHAVIOR OF FAMILY OR CAREGIVER • 􀂄 Alcohol or drug use by family • 􀂄 Withholds food, medication • 􀂄 Isolates individual from others in the household • 􀂄 Lack of physical, facial, eye contact with individual • 􀂄 Changes doctor frequently without specific cause • 􀂄 Past history of similar incidents • 􀂄 Resentment, jealousy • 􀂄 Unrealistic expectations of individual

24. HIGH RISK CIRCUMSTANCESFOR ABUSE, NEGLECT, ANDEXPLOITATION • 􀂄 A vulnerable adult is becoming weak and dependent. • 􀂄 A vulnerable adult is living with family where thereare crises. • 􀂄 Elderly children are caring for elderly parents or elderly spouse is caring for disabled partner. • 􀂄 There are no witnesses. • 􀂄 A vulnerable adult is incontinent. • 􀂄 Adult children are supporting both ends of life cycle, financially, physically, and emotionally. • 􀂄 The living situation is overcrowded.

25. ADDITONAL FACTORSHIGH RISK CIRCUMSTANCESFOR ABUSE, NEGLECT, ANDEXPLOITATION • 􀂄Adult children who are mentally ill, developmentally disabled or substance abusers. • 􀂄 There is a desire for the person’s inheritance. • 􀂄 There is a family history of abuse. • 􀂄 The vulnerable adult wasn’t a nurturing parent. • 􀂄 There is a piling up of stresses. • 􀂄 The vulnerable adult has always been demanding, selfish and hard to live with. • 􀂄 The vulnerable adult prefers to die rather than lose independence and control. • 􀂄 An adult child has moved back to the parent’s home after a job loss and/or divorce.

26. BARRIERS TO IDENTIFICATIONOF ABUSE AND NEGLECT • 􀂄The victim is dependent on the “abuser” for basic needs. • 􀂄 The victim refuses to acknowledge the problem. • 􀂄 The victim feels too embarrassed or guilty. • 􀂄 The victim is unaware of other options. • 􀂄 The victim fears that the solution to the problem is more negative or frightening than the problem. • 􀂄 The victim is fearful they will have to enter a nursing home.

27. Mandatory Reporting Requirements Mandatory Reporter is required to report such knowledge or suspicion to the Florida Abuse Hotline at 1-800-96-ABUSE or 1-800-962-2873. Failure to report known or suspected cases of abuse, neglect, or exploitation is a criminal offense. A Mandatory Reporter is required to report the following: • Any person who knows, or has reasonable cause to suspect, that a person with a disability is being abused, neglected, or exploited by a relative, caregiver, or household member or, in the case of self-neglect, by themselves.

28. As a Mandatory Reporter, Be Prepared to Provide the Following Information: • Victim’s name, address or location, approximate age, race and sex. • Physical, mental or behavioral indications that the person is disabled. • Signs or indications of harm or injury, including a physical description if possible. • Relationship of the alleged possible responsible person to the victim. If the relationship is unknown, a report will still be taken if other reporting criteria are met.

29. INFORMATION YOU PROVIDE • All information obtained from interviews and other sources will be used to assess the risk to the victim and determine findings. • All information obtained during an investigation is confidential.

30. How Do I Make the Report? • REPORT ONLINE: http://www.dcf.state.fl.us/abuse/report/index.asp • TELEPHONE: 1-800-962-2873or 1-800-96-ABUSE (Telephone reporters will always be told prior to concluding your conversation, whether the information provided has been accepted as for further investigation.) • TDD (Telephone Device for the Deaf): 1-800-453-5145 • FAX:1-800-914-0004

31. PENALTIES, failing to report • (1) A person required by Section 415.103, Florida Statutes, to report a case of known or suspected abuse, neglect, or exploitation of a vulnerable adult, and who knowingly and willfully fails to do so or who knowingly and willfully prevents another person from doing so, commits a misdemeanor of the second degree, punishable as provided in Sections 775.082 or 775.083

32. PENALTIES, confidential information • (2) A person who knowingly and willfully makes public or discloses any confidential information contained in the central abuse registry and tracking system, in other computer systems, or in the records of any case of abuse, neglect, or exploitation of a vulnerable adult, except as provided in Section 415.101-113, Florida Statutes, commits a misdemeanor of the second degree, punishable as provided in Sections 775.082 or 775.083.

33. PENALTIES, false reporting • (3) A person who knowingly and willfully makes a false report or who advises another to make a false report commits a felony of the third degree, punishable as provided in Sections 775.082 or 775.083.

34. Please Remember…… As Medicaid Waiver Providers, we are here to make every effort to ensure the health, safety and well-being of all clients served in our programs. If you suspect any Abuse, Neglect and/or Exploitation, please report it immediately. The statewide toll-free telephone number: Available 24 hrs/ 7 days a week Florida Abuse Hotline @ (1-800-96-ABUSE or 1-800-962-2873) http://www.dcf.state.fl.us/abuse/report/index.asp

35. References & More Information • Department of Children and Families: http://www.dcf.state.fl.us/programs/aps/Reporting.shtml • Department of Elder Affairs: http://elderaffairs.state.fl.us/doea/abuse_prevention.php • To Learn More, Call: 1-800-96-ELDER (1-800-963-5337)